Provider Demographics
NPI:1750900130
Name:BISHARD, SHELLY (PMHNP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:BISHARD
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-4333
Mailing Address - Country:US
Mailing Address - Phone:214-491-9112
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY STE 1101
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5147
Practice Address - Country:US
Practice Address - Phone:469-444-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145840363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health